East Africa Has Weathered Pandemics — and Has a Few Things to Teach the U.S.
A willingness to learn from history and science, take preventive measures and seek international cooperation has prepared the continent to fight covid-19
Truck drivers crossing the border into Uganda from Kenya line up to be tested for coronavirus. (Brian Ongoro/AFP/Getty Images)
By Edward H. Carpenter and Charli Carpenter
May 2, 2020: The current pandemic won’t be the last the world faces. And while it is functionally too late for the United States to do anything but fight its way through the coronavirus crisis, it can start to look for examples of better ways to deal with the next one.
Those ways can be found in East Africa.
It’s easy to look toward South Korea and Taiwan for examples. High-tech societies — with a cultural bias toward such transmission-blocking behaviors as wearing masks, a history of strong direction by central governments, and the resources to deploy testing and contact tracking on a massive scale — have been highly successful at containing the virus. Less noticed is how well other countries are doing relative to the United States, including many in East Africa.
This may seem surprising to those raising the alarm about what to expect when the virus sweeps the developing world. The World Health Organization’s regional director recently warned of “social and economic devastation” in Africa, as confirmed cases and deaths began to climb. Even some stable African countries have high poverty rates and minimal access to health care, which create a tinderbox for pandemics.
In addition, many countries in Africa, like elsewhere, suffer from conflict and civil war — conditions that exacerbate the potential for deadly disease beyond what is already seen in stable, wealthy countries. Conditions in refugee camps can make social distancing impossible. Health and humanitarian services may already be overstretched; donor money may wane as wealthy countries turn inward. And warring parties may take advantage of the situation.
These factors make it all the more remarkable that emerging economies of East Africa are far better prepared for this crisis than the United States was even two weeks ago. These countries include some of the more stable African nations (Uganda, Kenya, Ethiopia and Eritrea) and some of the most unstable (Somalia, Sudan and South Sudan). What they share is a relatively low incidence of the coronavirus and a strong, proactive and coordinated response to the crisis.
Three things stand out in East Africa’s preparedness.
First, their governments took early preventive measures. In March, while President Trump was saying that the virus was “something that we have tremendous control of,” the presidents of South Sudan, Kenya and Uganda issued detailed proclamations and decreed strong measures to delay the arrival of it and suppress its spread — in most cases before any cases had been detected.
Ugandan President Yoweri Museveni was particularly eloquent and detail-oriented, explaining what the virus was, how it was transmitted and who was at risk, before laying out a plan to systematically close schools, churches and borders, to begin social distancing, and to put a hold on weddings and funerals. South Sudan, Kenya and Uganda all shut down cross-border air and ground travel for passengers, while maintaining the regional cargo links that are especially important for landlocked South Sudan.
Notably, all of these measures were rolled out in a controlled manner without political posturing, and with reasonable time built in to set the guidelines in motion. Kenya gave 48 hours for foreign visitors to leave the country or enter quarantine; Uganda systematically shut primary schools and then universities over the course of a week. While economic costs were noted (the travel restrictions effectively killed the major tourism sector for Kenya and Uganda), the governments put public health over profits.
Second, experience seeded these states’ ability to respond quickly and effectively; this is not their first time dealing with a deadly pandemic. Cholera, influenza, HIV-AIDS and Ebola preceded covid-19, the disease caused by the novel coronavirus. The United States has also had its share of pandemics: yellow fever, the 1918 flu, HIV-AIDS and SARS. The difference may be a willingness to put lessons learned into action. As Museveni put it, “By confronting this disease with enlightened, scientifically based actions, we shall defeat it as we did with Ebola three times, with Marburg and with AIDS.” As a result, case counts and fatalities have so far been extremely low in Africa generally (not quite 40,000 cases and 1,640 deaths so far across a continent with a population of over a billion, according to Africa Centers for Disease Control and Prevention) and particularly low in East Africa. Most countries in this region have fewer than 500 recorded cases.
And a third reason for the region’s preparedness, relative to that of the United States, is an emphasis on international cooperation. These countries make up the membership of the Intergovernmental Authority on Development (IGAD). The organization met March 30 by video-teleconference and resolved to jointly formulate a regional response, establish an emergency fund and mobilize support from the global community and from IGAD medical professionals in the diaspora.
The crisis has even caused some prominent local leaders to double down on a global approach to economic policy, with Museveni saying: “I have warned our people to stop talking like the selfish foreigners by trying to stop the little we have being exported to other African countries. We can keep a bit for ourselves, but we shall share with the others whatever we have.”
The arrival of the virus on the continent has also given rise to local innovation. Researchers at Uganda’s Makekere University are developing a faster, cheaper coronavirus test, while college students and manufacturers in Kenya are piloting ways to assemble ventilators from locally sourced components.
The region has willingly benefited from international beneficence: Chinese billionaire Jack Ma has donated millions of test kits and face masks, and tens of thousands of sets of protective equipment to African states; the United States, Canada, Germany and China have given millions of dollars in coronavirus-related aid to South Sudan alone; and there is already an extensive network of humanitarian organizations operating in the region, which can help shore up countries whose national medical infrastructure is weak.
None of this means that IGAD states will remain largely immune to the impact of the global pandemic. As in most of the world, testing has remained limited, and in Africa, communicable diseases (lower respiratory tract infections, HIV, diarrhea, malaria and tuberculosis) already account for 35 percent of all deaths. Respiratory illness and malaria have symptoms similar to covid-19, so the actual infection and death rates may be grossly underestimated, with those who die and those who recover being written off as just having had a case of malaria. Conversely, absent testing, those showing such symptoms as fever, chills, headaches and stomach pain may be assumed by local populations to be suffering from covid-19, as opposed to malaria. This could drive panic and even persecution of the victims and their families.
Antibody tests show we’re nowhere near herd immunity
What is notable about these East African states, however, is their proactive and symbiotic approach to the overall crisis, and their apolitical information management. For example, while most IGAD states halted their international and regional passenger flights, Ethiopia kept a single air connection into the region open to the rest of the world, thus minimizing the regional risk of contagion while keeping a pipeline open for such critical cargo as the donations from Ma and for aid workers and medical personnel to enter under strict guidelines. South Sudan, which had formed its Transitional Government of National Unity just weeks before, has a covid-19 task force, led by First Vice President Riek Machar. The task force publishes detailed updates almost daily, and President Salva Kiir has made public addresses calling on the population to remain calm and not blame aid workers for the crisis.
The East African situation has implications for the United States. First, there is a high probability that the difference between the American and Chinese approaches to helping the countries deal with the pandemic will further tilt the region toward China’s sphere of influence. This could be exacerbated if the American military and diplomatic planners choose to pull their people out, as has already happened with the Peace Corps, whose forced evacuation of all volunteers resulted in over 1,000 “ambassadors of goodwill” leaving East African countries at a time when they are needed most. Such a move, even done in the name of risk avoidance, would most likely cause irreparable reputational harm to the United States in a region that may be one of the great emerging markets.
The United States and powerful developed countries can benefit from the example of Africa, where humility about the capacity to treat diseases makes societies favor measures to prevent them; where there’s a willingness to learn from experience, rather than disregard science and rewrite history; and where reaching out to neighbors in a spirit of mutual assistance and cooperation helps stave off transnational threats.